Stories, insights and ideas from Northeastern's J-school

by Patrick Johnston | Ruggles Media

Doctors in Boston and around the country might be financially influenced by the pharmaceutical industry even more than previously believed. And said influence is coming in a form that you might not expect; a free burger and fries. Doctors are regularly treated to meals by pharmaceutical representatives trying it convince them to sell their company’s drug. And this might be dramatically affecting doctors’ decisions about prescribing drugs.

Now you might be thinking, “Oh, come on, a free lunch? No doctor’s going to change his medical practices for fish n’ chips, right?” Well, apparently, they might. Because a recent study, published in the Journal of the American Medical Association (JAMA), found that free meals can seriously influence a doctor’s prescribing habits. In fact, the study found that a single sponsored meal from a drug company can boost the likelihood of the doctor prescribing that company’s drug by as much as 118%. What’s more, these are not exactly epic feasts that doctors are being invited to, the vast majority of the meals represented in the study are under 20 dollars in value. In short, pharmaceutical companies can potentially double the likelihood of their drug being prescribed for less than 20 dollars.

Much has been made in the last few years of the financial influence that drug manufacturers can have on doctors. And now, thanks to a clause in the Affordable Care Act, the Centers for Medicare and Medicaid Services (CMS) has been collecting data on payments made to doctors by the pharmaceutical industry since August of 2013. Now it’s not difficult for members of the public to find doctors who have taken thousands of dollars from a drug manufacturer, either in funds for research, or fees for speaking at company events, or medical consultations. Most of the concern about this issue has been paid to these kinds of contributions. But doctors receiving free food from pharmaceutical reps. might be a much bigger concern than previously thought.

Of course this new evidence doesn’t lessen the problems with potentially corrupting research grants, or other contributions. It is true that payments for food constitute a small percentage of the industry’s total spending when it comes to how they peddle their drugs to doctors. According to data obtained from the CMS, in 2015 only 2.7% of the money spent by the industry to doctors in Boston was for food.

But of all forms of financial influence, free food is by far the most wide spread. In fact, according to that same data it was by far the most common kind of payment made by the industry. Over half the payments made to doctors in Boston in 2015 were for food, and the next largest category; grants at less than half the size.

And for most doctors in Boston, this is the only kind of financial influence by pharmaceutical companies they will ever encounter. According to the data 55% of doctors in Boston who have received payments from the industry have only ever received them in the form of free food. And given this new evidence it might just be the most cost-effective form of pharmaceutical influence over doctors, at least in Boston.

This practice of providing doctors with food is something that has been around for a very long time, it’s so common that according to Jamie Reidy, a former Pfizer representative and Huffington Post blogger, some practices he encountered even advertised free lunch as a perk for the front desk job because people like him were providing it nearly every day. A few years ago, PhRMA, the trade group for the industry, claimed they were introducing new rules limiting the kinds of meals that company representatives are be allowed to provide doctors with, but given recent findings it doesn’t seem that such guidelines did much. Assuming that the guidelines are being followed at all, which is questionable given how many of the payments represented in the data are well over twenty dollars.

And beyond the question of ethical corruption, it’s interesting to note that doctors are some of the highest paid professionals in the United States. Keeping that in mind it seems a bit strange that these companies are spending so much money courting the favor of some of the highest paid people in the country while they are supposed to be spending their time and money developing drugs that improve the lives of the public. Of course, the amount spent providing doctors free lunch is a small part of their marketing budget, but these companies still spend a huge amount of money to pay for something that doctors can easily pay for themselves.

And it’s not just the public that is concerned about issues of pharmaceutical influence and improper spending, many in the medical community are as well. Most notably, Robert Steinbrook, Editor-at-Large for JAMA Internal Medicine, who said in an editorial note pertaining to the before discussed study, “If drug and device manufacturers were to stop sending money to physicians for promotional speaking, meals, and other activities without clear medical justifications and invest more in independent bona fide research on safety, effectiveness, and affordability, our patients and the health care system would be better off.”

Ultimately doctors are human, and are prone to the same biases and influences that all of us are. Which is bad news for those who want to have prescriptions written based on their physician’s best medical judgment, rather than on how good the chicken parmesan the last pharmaceutical rep. brought in was. So, what’s the good news? Well, if you have a crush on your doctor, apparently, you won’t have to spend much on dinner.